9.
Sickness and HIV: if the individual in Johannesburg becomes too sick to work, the majority will return back home Support 54 % 67% Importance of food Burden on the household back home. Urban livelihood that supports another household ‘back home’ would be affected.

10.
Food Security in Johannesburg: Key Findings from Sol Plaatjie and the Inner City Food security measured as an outcome of a diverse livelihood strategy Explored through comparing the Inner City to the Urban Informal Many important indicators and measurements:

15.
Strategies to cope with food insecurity Strategies to cope with food shortage 0 50 100 150 200 250 rely on hh members rely on hh members and grant money do extra work borrow from relatives outside the hh borrow from friends and neighbours rely on boyfriend nobody to rely upon relative frequencies (%) strategies

16.
Dietary Diversity Score <ul><li>A variety of foods in the diet is required to ensure an adequate intake of essential nutrients . Dietary diversity reflects the number of foods or food groups eaten over a reference period. </li></ul><ul><li>Dietary diversity can be used as an indicator of micro-nutrient adequacy (Steyn et al 2006), and as a proxy measure of the nutritional quality of the diet (Swindale and Bilinsky 2005). </li></ul><ul><li> </li></ul><ul><li>Dietary diversity scores have been positively associated with the nutritional status of young children (Arimond and Ruel 2004) and adults (Savy et al 2007), independent of socio-economic factors. </li></ul><ul><li>Steyn et al (2006) showed a strong relationship between dietary diversity and child growth for South African children. </li></ul>

21.
Implications of an Inadequate Diet <ul><li>Refined foods among lowest cost sources of energy </li></ul><ul><li>More nutrient dense foods (lean meat, vegetables and fruit) are more costly. </li></ul><ul><li>In 2006 many healthier food items were 50% more expensive than comparable less healthy ones. </li></ul><ul><li>Low-income people will often select a diet with a high content of refined cereals, sugar and fat (Temple & Steyn, 2009). </li></ul><ul><li>Suggests economic factors may lead to selection of unhealthy diet. However, other factors such as taste and convenience are important. </li></ul>

22.
Implications of an Inadequate Diet <ul><li>High content of sugar and fat in cheap, less healthy foods causes them to have high energy density (ED) </li></ul><ul><li>Many investigators speculate that diets with high ED may be responsible for high prevalence of obesity in people of low socio-economic status. </li></ul><ul><li>South Africa has a high prevalence of both under-nutrition and over-nutrition. Poor quality of available food may contribute to both conditions. </li></ul><ul><li>An energy-dense diet may be one of the major causes leading to overweight and obesity and micronutrient deficiencies in infants and children. </li></ul>

23.
[1 GAIn, 2009 ; Steyn et al. 2005 ; Kruger et al. 2007 Comparison of stunting for children aged 1-9 years nationally and by area of residence: South Africa 1999 and 2005

24.
HIV/AIDS and nutrition are inextricably interrelated, particularly in Africa <ul><li>Malnutrition and food insecurity are endemic in Africa, where more than 25 million people are living with HIV </li></ul><ul><li>Nearly 40% of African children < 5 are moderately or severely stunted (low height-for-age) </li></ul><ul><ul><li>> 50% also suffer from micronutrient deficiency disorders </li></ul></ul><ul><li>Malnutrition is not limited to children. </li></ul><ul><ul><li>> 50% of all pregnant women are anemic </li></ul></ul>

25.
What can be done? <ul><li>Costs of Improving Diets a Challenge. Temple and Steyn, 2009: </li></ul><ul><li>Extra cost of a healthier diet was roughly R198 per month, an amount that represents between 10% and 20% of the entire family budget (Khayelitsha) </li></ul><ul><li>Based on food price data collected in 2006. </li></ul>